Adolescent Distal Ulna Physeal Fracture with Extensor Retinaculum Interposition

Area of Science:

• Orthopedics
• Pediatric Orthopedics
• Traumatology

Background:

• Isolated distal ulna fractures are uncommon, often associated with distal radius fractures.
• Conservative management is typical, but some cases require surgical intervention due to interposition of soft tissues.
• These injuries are particularly concerning in pediatric and adolescent patients due to potential growth arrest.

Observation:

• This report details two cases of irreducible isolated distal ulna fractures in adolescents.
• The irreducibility was caused by the interposition of the extensor retinaculum and its tendons.
• Surgical intervention was required to achieve bony union and restore distal radioulnar joint stability.

Findings:

• Open reduction with hypersupination and maintaining the distal ulna shaft's gothic arch using pins is an effective technique.
• Successful bony union and distal radioulnar joint stability were achieved in both cases.
• These fractures can be considered equivalent to Triangular Fibrocartilage Complex (TFCC) injuries in adults.

Implications:

• Gross displacement or difficult reductions in distal ulna fractures should prompt consideration of soft tissue interposition.
• Open reduction is crucial for irreducible fractures, ensuring distal radioulnar joint congruity.
• Accurate articular reduction is less critical than maintaining overall distal radioulnar joint stability.